Kontroverze kod operacija na limfnom sustavu kod bolesnika s karcinomom dojke

Axillary lymph node status is a major prognostic factor in early-stage breast cancer. It provides information important for the following surgical procedures. Since imaging techniques have limited sensitivity for the detection of metastasis in axillary lymph nodes, the axilla must be surgically explored. The histology of all resected nodes at the time of axillary lymph node dissection (ALND) has traditionally been regarded as the most accurate method for assessing metastatic spread to regional lymph nodes. However, ALND is often connected to lifequality - reducing side - effects such as lymphedema, dysesthesia, shoulder dysfunction, and other short-term and long-term complications. Sentinel lymph node biopsy (SLNB), introduced in the 1990s, was a milestone that permitted avoidance of axillary dissection if the sentinel node was disease-free. SLNB is less invasive and it has been verified that there is decreased morbidity and less negative side-effects when compared to axillary lymph node dissection (ALND). SLNB relies on the notion that tumor drains in an orderly manner through the lymphatic system. The sentinel lymph node (SLN) should, therefore, be first affected, and a tumor-negative SLN makes it highly unlikely for the other lymph nodes to be affected. SLNB has been established as the gold standard for regional axillary staging. Its use in breast cancer has been evaluated in several randomized controlled trials and validated in multiple prospective studies. However, even today, there are some unresolved questions concerning SLNB and ALND that are still being debated.Status aksilarnih limfnih čvorova je važni prognostički faktor kod raka dojke u ranom stadiju. Pruža informacije važne za daljnje kirurške procedure. S obzirom na to da tehnike snimanja imaju ograničenu osjetljivost za detekciju metastaza u aksilarnim limfnim čvorovima, aksila zahtjeva kiruršku eksploraciju. Histologija svih reseciranih čvorova za vrijeme disekcije aksilarnih limfnih čvorova (ALND) je tradicionalno bila smatrana kao najpreciznija metoda utvrđivanja metastatskog širenja u regionalne limfne čvorove. Međutim, ALND često povezujemo s ozbiljnim nuspojavama kao što su limfedem, disestezija, disfunkcija ramena i ostale kratkoročne i dugoročne komplikacije. Biopsija limfnog čvora stražara (SLNB), uvedena 1990-ih, predstavlja prekretnicu koja je omogućila izbjegavanje aksilarne disekcije ako je čvor stražar bez bolesti. SLNB je manje invazivna i potvrđeno je da nosi manju smrtnost i manje nuspojava u usporedbi s disekcijom limfnih čvorova aksile. SLNB se oslanja na ideju da se tumor širi po redoslijedu kroz limfni sustav. Limfni čvor stražar (SLN) je, prema tome, prvi zahvaćen i tumor-negativni SLN ukazuje na malu vjerojatnost da su ostali limfni čvorovi zahvaćeni. SLNB je uspostavljen kao zlatni standard regionalnog aksilarnog stupnjevanja. Korisnost kod raka dojke je procijenjena kroz nekoliko randomiziranih kontroliranih pokusa i potvrđena u višebrojnim prospektivnim istraživanjima. Međutim, postoje neka nerazjašnjena pitanja u pogledu SLNB i ALND oko kojih se i danas debatira